scholarly journals Post-Transplant Work Status of Young Adult Survivors of Allogeneic Hematopoietic Cell Transplant: A Report from the Center for International Blood and Marrow Transplant Research (CIBMTR)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 706-706
Author(s):  
Neel S. Bhatt ◽  
Ruta Brazauskas ◽  
Stephanie Bo-Subait ◽  
Rachel B. Salit ◽  
Karen Syrjala ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Hematopoietic Cell ◽  
Work Status ◽  
Cell Transplant ◽  
Full Time ◽  
Hematopoietic Cell Transplant ◽  
Myeloablative Conditioning ◽  
Allogeneic Hct ◽  
Time Work ◽  
Time Point

Background: Return to full-time work after hematopoietic cell transplant (HCT) is an important indicator of health recovery and overall function of survivors. Because young adult (YA) HCT patients are at a critical personal and professional developmental phase at the time of their illness, they face unique challenges potentially impacting their ability to work post-HCT. We aimed to assess the post-HCT work status of YA patients undergoing allogeneic HCT and examine pre-HCT factors associated with their work status at the 1-year time-point post-HCT. Methods: Using data from the Center for International Blood and Marrow Transplant Research (CIBMTR), we studied YA (18-39 years of age at HCT) survivors (alive ≥1-year post-HCT) of allogeneic HCT performed between 2008 and 2015 for malignant or non-malignant conditions. All conditioning regimens, stem cell sources, and donor types were included. Work status [full-time (FT), part-time (PT), unemployed, medical disability] was assessed at 6-months, 1-, 2-, and 3-years post-HCT. We performed a multivariable logistic regression to study the pre-HCT patient and disease related [patient age at HCT, sex, race/ ethnicity, pre-HCT education, pre-HCT work status, disease diagnosis, Karnofsky/ Lansky performance score, hematopoietic cell transplant comorbidity index (HCT-CI), marital status], and HCT-related (year of transplant, stem cell source, donor type, conditioning regimen) factors associated with post-HCT work status at the 1-year time-point [dichotomized as employed (in FT/PT work) vs unemployed (unemployed, medical disability)]. Results: A total of 1,365 allogeneic HCT recipients met the selection criteria. Median age at HCT was 30.8 years (range 18-39; interquartile range 9.3). Forty-four percent were females; 89% received HCT for malignant diseases (myeloid diseases: 62%, lymphoid diseases: 35%) and the remainder for non-malignant diseases (severe aplastic anemia, inherited abnormalities of erythrocyte differentiation/ function, and disorders of the immune system). Forty three percent received total body irradiation (TBI) based myeloablative conditioning regimens. Median follow-up time from HCT was 60.6 months (range: 12-121). From 6-months to 3-years post-HCT, the percentage of survivors employed FT (18% to 51%) and PT (7% to 11%) increased, and unemployed (38% to 18%) and on medical disability (37% to 20%) decreased (Figure 1). Of patients in FT work pre-HCT, 50% were either unemployed or had medical disability status at the 1-year time-point (Figure 2). Of those unemployed pre-HCT, 19% were working at 1-year post-HCT. In the multivariable logistic regression, survivors' pre-HCT work status was significantly associated with the post-HCT work status at 1-year time-point. Compared to patients working FT pre-HCT, patients who were unemployed and on medical disability were significantly less likely to be employed at 1-year post-HCT [pre-HCT unemployment: odds ratio (OR) of FT/PT employment 0.30; 95% confidence interval (CI) 0.20-0.48; pre-HCT medical disability: OR 0.46; 95% CI 0.30-0.71]. Females (OR 0.51; 95% CI 0.37-0.69) and patients with an HCT-CI score of 2 (OR 0.61; 95% CI 0.39-0.95), and ≥3 (OR 0.53; 95% CI 0.36-0.76) also had a lower likelihood of employment. Compared to patients with high school or lower education, patients with graduate school level education had significantly higher likelihood of employment (OR 2.53; 95% CI 1.72-3.71). Compared to patients treated with total body irradiation (TBI) based myeloablative conditioning, significantly higher odds of employment were seen in chemotherapy-based myeloablative conditioning (OR 1.81; 95% CI 1.28-2.56) (Table). Conclusions: In YA HCT survivors, the full-time and part-time work rates steadily improved post-HCT. Nonetheless, nearly 40% were still either unemployed or on medical disability even at 3 years post-HCT. Although there were limitations of the study including lack of post-HCT time-dependent covariates for the analysis and direct patient report for work status, our study findings provide an insight into the factors impinging on YA survivors' ability of returning to work and points to a need for return to work interventions. Disclosures Shaw: Therakos: Other: Speaker Engagement.

scholarly journals 1001. Feasibility and Outcomes of a Pre-Transplant Antibiotic Allergy Evaluation Program for Allogeneic Hematopoietic Cell Transplant (HCT) Candidates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S351-S352
Author(s):  
Catherine Liu ◽  
Elizabeth M Krantz ◽  
Erica J Stohs ◽  
Hannah Imlay ◽  
Lahari Rampur ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Hematopoietic Cell ◽  
Antibiotic Prescribing ◽  
Cell Transplant ◽  
Infection Prophylaxis ◽  
Hematopoietic Cell Transplant ◽  
Pneumocystis Jiroveci ◽  
Evaluation Program ◽  
Allogeneic Hct ◽  
Antibiotic Allergy

Abstract Background Antibiotic allergies impact the management of hematopoietic cell transplant (HCT) patients who are often prescribed antibiotics for infection prophylaxis and treatment. We evaluated the feasibility and outcomes of an antibiotic allergy evaluation program prior to allogeneic HCT. Methods In August 2017, we implemented a program to expedite allergy clinic referrals for adult allogeneic HCT candidates who reported an antibiotic allergy at their initial pre-transplant evaluation visit (PTEV). Allergy labels and clinical data including outcomes of allergy evaluation were prospectively collected for patients with PTEVs between 8/10/17 and November 15/18. The use of selected antibiotics was collected in the 100 days following HCT among patients with a reported β-lactam allergy (BLA). Choice of prophylactic agent for Pneumocystis jiroveci among patients with reported sulfa allergies was assessed among HCT recipients after engraftment. Results Of 276 allogeneic HCT candidates, 109 (39.5%) reported >= 1 antibiotic allergy (Table 1). Of the 109, 69 (63%) were referred for allergy evaluation; 83% (57/69) of those referred were evaluated at a median of 14 days after PTEV, and a median of 18 days before transplant. Among evaluated patients, 45 (79%) had >= 1 antibiotic allergy de-labeled including 74% (28/38) of those with BLA (Figure 1). Of the 10 patients whose BLAs could not be delabeled, 1 had a possible immediate IgE-mediated reaction, 5 had a delayed type IV hypersensitivity, and 4 had other reactions or required additional testing. Post-transplant antibiotic use among evaluated vs. nonevaluated patients reporting BLA is shown in Figure 2. Among 31 patients with reported sulfa allergies who underwent HCT, those who were evaluated received TMP-SMX rather than alternative prophylaxis more often (48%; 11/23) than those who were not evaluated (25%; 2/8). 10 (43%) of 23 evaluated patients were delabeled; 7 of 10 delabeled patients received TMP-SMX. Conclusion Antibiotic allergies are frequently reported among HCT candidates. Pre-transplant antibiotic allergy evaluation was feasible, led to de-labeling of the majority of reported allergies, and may alter antibiotic prescribing and increase the use of preferred agents following transplant. Disclosures All authors: No reported disclosures.

Infectious Causes of Acute Gastroenteritis in US Children Undergoing Allogeneic Hematopoietic Cell Transplant: A Longitudinal, Multicenter Study

2019 ◽  
Vol 9 (4) ◽  
pp. 421-427 ◽  
Author(s):  
Jennifer E Schuster ◽  
Samantha H Johnston ◽  
Bhinnata Piya ◽  
Daniel E Dulek ◽  
Mary E Wikswo ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Hematopoietic Cell ◽  
Mortality Data ◽  
Molecular Testing ◽  
Case Report Form ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Prospective Longitudinal Study ◽  
Allogeneic Hct ◽  
Prospective Longitudinal

Abstract Background Acute gastroenteritis (AGE) in hematopoietic cell transplant (HCT) patients causes significant morbidity and mortality. Data regarding the longitudinal assessment of infectious pathogens during symptomatic AGE and asymptomatic periods, particularly in children, are limited. We investigated the prevalence of AGE-associated infectious pathogens in children undergoing allogeneic HCT. Methods From March 2015 through May 2016, 31 pediatric patients at 4 US children’s hospitals were enrolled and had stool collected weekly from pre-HCT through 100 days post-HCT for infectious AGE pathogens by molecular testing. Demographics, clinical symptoms, antimicrobials, vaccination history, and outcomes were manually abstracted from the medical record into a standardized case report form. Results We identified a pathogen in 18% (38/206) of samples, with many detections occurring during asymptomatic periods. Clostridioides difficile was the most commonly detected pathogen in 39% (15/38) of positive specimens, although only 20% (3/15) of C. difficile–positive specimens were obtained from children with diarrhea. Detection of sapovirus, in 21% (8/38) of pathogen-positive specimens, was commonly associated with AGE, with 87.5% of specimens obtained during symptomatic periods. Norovirus was not detected, and rotavirus was detected infrequently. Prolonged shedding of infectious pathogens was rare. Conclusions This multicenter, prospective, longitudinal study suggests that the epidemiology of AGE pathogens identified from allogeneic HCT patients may be changing. Previously reported viruses, such as rotavirus and norovirus, may be less common due to widespread vaccination and institution of infection control precautions, and emerging viruses such as sapoviruses may be increasingly recognized due to the use of molecular diagnostics.

scholarly journals 1756. Role of Human bocavirus Respiratory Tract Infection in Hematopoietic Cell Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S645-S645
Author(s):  
Chikara Ogimi ◽  
Emily T Martin ◽  
Hu Xie ◽  
Angela P Campbell ◽  
Alpana Waghmare ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Retrospective Review ◽  
Respiratory Symptoms ◽  
Hematopoietic Cell ◽  
Human Bocavirus ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hct

Abstract Background Limited data exist regarding the impact of human bocavirus (BoV) in hematopoietic cell transplant (HCT) recipients. We examined incidence and disease spectrum of BoV respiratory tract infection (RTI) in HCT recipients. Methods In a longitudinal surveillance study of viral RTIs among allogeneic HCT recipients, pre-HCT and weekly post-HCT nasal washes and symptom surveys were collected through day 100, then every 3 months, and whenever respiratory symptoms occurred through 1-year post-HCT. Samples were tested by multiplex semi-quantitative PCR for RSV, parainfluenza virus 1–4, influenza A/B, adenovirus, human metapneumovirus, rhinovirus, coronavirus, and BoV. Plasma samples from BoV+ subjects were analyzed by PCR. In addition, we conducted a retrospective review of HCT recipients with BoV detected in bronchoalveolar lavage or lung biopsy. Results Among 469 patients in the prospective cohort, 21 distinct BoV RTIs (3 pre-HCT and 18 post-HCT) were observed by 1-year post-HCT in 19 patients (median 42 years old, range 0–67) without apparent seasonality. BoV was more frequently detected in the latter half of the first 100 days post-HCT (Figure 1). The frequencies of respiratory symptoms in patients with BoV detected did not appear to be higher than those without any virus detected, with the exception of watery eyes (P < 0.01) (Figure 2). Univariable models among patients with BoV RTI post-HCT showed higher peak viral load in nasal samples (P = 0.04) and presence of respiratory copathogens (P = 0.03) were associated with presence of respiratory symptoms; however, BoV detection in plasma was not (P = 0.8). Retrospective review identified 6 allogeneic HCT recipients (range 1–64 years old) with BoV detected in lower respiratory tract specimens [incidence rate of 0.4% (9/2,385) per sample tested]. Although all 6 cases presented with hypoxemia, 4 had significant respiratory copathogens or concomitant conditions that contributed to respiratory compromise. No death was attributed mainly to BoV lower RTI. Conclusion BoV is infrequently detected in respiratory tract in HCT recipients. Our studies did not demonstrate convincing evidence that BoV is a significant pathogen in either upper or lower respiratory tracts. Watery eyes were associated with BoV detection. Disclosures All authors: No reported disclosures.

scholarly journals Safety of Live-Attenuated Measles, Mumps, and Rubella Vaccine Administered Within 2 Years of Hematopoietic Cell Transplant

2021 ◽  
Vol 8 (12) ◽  
Author(s):  
Michaël Desjardins ◽  
Xhoi Mitre ◽  
Amy C Sherman ◽  
Stephen R Walsh ◽  
Matthew P Cheng ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Maculopapular Rash ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Mmr Vaccine ◽  
Hematopoietic Cell Transplant ◽  
Live Attenuated Vaccine ◽  
Allogeneic Hct ◽  
Measles Outbreak ◽  
Tract Infections

Abstract Background Measles, mumps, and rubella (MMR) vaccine is a live-attenuated vaccine usually contraindicated within the first 2 years of hematopoietic cell transplant (HCT). The objective of this study was to assess the safety of MMR vaccine when administered within 2 years of HCT. Methods We conducted a retrospective review of patients who received MMR vaccination within 2 years of an autologous or allogeneic HCT, mostly in the context of the 2019 measles outbreak. Adverse reactions were collected for 42 days postvaccination, and all hospitalizations and deaths following vaccination were reviewed. Results A total of 129 patients (75 autologous and 54 allogeneic HCT) were vaccinated 300–729 days after HCT (median, 718 days), and 39 (30%) of these were vaccinated earlier than 23 months post-transplant. Ten adverse reactions in 7 patients (5%) were identified within 42 days of vaccination: 6 respiratory tract infections (3 with fever) and 1 rash. The rash was seen in a 37-year-old female who had an allogeneic HCT 542 days before vaccination. She presented with a centrifugal maculopapular rash, confirmed to be caused by the vaccine strain rubella virus. She fully recovered. No other vaccine-associated illness was identified in the cohort after a median follow-up of 676 days. Conclusions MMR vaccine appears to be well tolerated in select HCT recipients when given between 300 and 729 days after transplant. An uncomplicated case of vaccine-associated rubella illness was seen after vaccination. Assessment of potential risks and benefits of MMR vaccination given within 2 years of HCT remains important.

Allogeneic hematopoietic cell transplant for multiple myeloma: Comparative results of planned therapy versus salvage therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7035-7035
Author(s):  
L. Shune ◽  
D. J. Weisdorf ◽  
B. McClune ◽  
L. Ma ◽  
L. J. Burns ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Salvage Therapy ◽  
Therapy Group ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hct ◽  
Autologous Hct ◽  
Related Mortality

7035 Background: Despite advances in therapy for multiple myeloma, the disease remains incurable using chemotherapy or immune-modulating agents alone. Several newer hematopoietic cell transplant (HCT) strategies including tandem HCT, and non- myeloablative (NMA) regimens have reported encouraging results. However, the appropriate timing for utilizing these strategies is not clear. Methods: We report outcomes in 51 patients with multiple myeloma who received an allogeneic HCT; either as salvage therapy (after failing a prior autologous HCT), n= 15 or as planned therapy, n= 36, between the years 1996 and 2008 at University of Minnesota. Results: Patients in salvage therapy group were significantly older than in planned therapy group (median age 58 versus 49 years) and had a longer interval from diagnosis to transplant (median 47 versus 10 months). Forty four patients received a HCT from a HLA-identical sibling. Five received umbilical cord blood (four in salvage therapy, one in planned therapy group) and two received unrelated donor HCT (one in each group). Thirteen patients in planned therapy group underwent a tandem transplant (planned autologous followed by NMA sibling HCT). All patients in salvage therapy group, and 50% in planned therapy group received NMA HCT. Patients in salvage therapy group were more heavily pre-treated, all having failed a prior autologous HCT. Complete response was seen in 34% versus 47% of recipients in the two groups, respectively. After a median follow-up of 24 and 41 months, similar relapse was seen, but transplant related mortality (TRM) was significantly higher in salvage therapy group, leading to significantly lower two year survival and disease free survival (DFS) in salvage group. Conclusions: Good overall survival and low transplant related mortality was seen in patients undergoing a planned allogeneic transplant. In heavily pre-treated patients, receiving allogeneic HCT as salvage therapy, despite lower relapse, the high TRM led to lower survival. [Table: see text] No significant financial relationships to disclose.

Relapse Prediction Post Allogeneic Hematopoietic Cell Transplant for Myelodysplastic Syndromes Is Not Improved with Use of the More Stringent Blast Percentage Categories in the Revised International Prognostic Scoring System

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2011-2011
Author(s):  
Leyla Shune ◽  
Zohar Sachs ◽  
Todd E. Defor ◽  
Michelle Dolan ◽  
Daniel J. Weisdorf ◽  
...  
Keyword(s):  
Scoring System ◽  
Disease Burden ◽  
Residual Disease ◽  
Hematopoietic Cell ◽  
International Prognostic Scoring System ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Myeloablative Conditioning ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Relapse Prediction

Abstract Abstract 2011 Residual disease at the time of allogeneic hematopoietic cell transplant (HCT) has been shown to adversely affect outcomes in patients with acute myelogenous leukemia (AML). Assessment of the impact of MDS disease burden at HCT on post-transplant outcomes is less well defined. While blast percentage is easily quantified on morphology and flow cytometry, the blast percentage captures only a fraction of the true MDS clone. Consequently, improved measures of residual disease in MDS patients are needed to improve post HCT outcome prediction. We hypothesized that a more stringent blast percentage cutoff as well as an assessment of recognizable residual cytogenetic disease burden would better predict outcome post HCT. Disease burden at HCT was characterized as reported in the Revised International Prognostic Scoring System (IPSS-R) (<2%, >2-<5%, 5–10% and >10%) and by assessment of cytogenetic residual disease by calculating the percent of metaphases with ongoing cytogenetic abnormalities immediately prior to transplant (% positive metaphases <25%, 25–50%, and > 50%). Metaphase data was unavailable in n=7. Those patients with normal cytogenetics (n=26) were classified in the <25% category. One hundred consecutive patients with MDS undergoing allogeneic HCT at the University of Minnesota between 1995 –2011 were studied. Their median age was 52 (18–69). At diagnosis, the majority of patients had either refractory cytopenia of multilineage dysplasia (RCMD) (25%) or refractory anemia with excess blasts (RAEB) 1 or 2 (49%) and were INT-1 (37%) or INT-2/High risk (60%). Donor type was related donor (52%), matched unrelated (13%) and umbilical cord blood (35%). Half received myeloablative conditioning and Karnofsky Performance Status (KPS) > 80 in 95%. Results: (Table) Both higher blast percentage at HCT and high percentage of residual cytogenetically positive cells correlated with inferior overall survival as well as more frequent NRM. Relapse incidence was similar in those with blasts up to 10%. Percentage of abnormal metaphases was not predictive of relapse. Conditioning intensity was the only factor that impacted the 2 year relapse rate with decreased relapse seen with myeloablative conditioning. Conclusion: These data suggest that survival and relapse prediction are not improved by using the more stringent IPSS-R blast cutoff of < 2% versus <5% at HCT. Additionally, our data suggest that use of a disease burden measure as represented by % residual positive metaphases at HCT may serve as another predictor of outcome. Survival and NRM were worse with >10% blasts or > 50% residual positive metaphases. These patients require additional therapy or new strategies to improve post HCT outcomes. A refined measure of disease burden at HCT using both blast count and % residual abnormal metaphases may allow for more comprehensive prediction of post HCT outcomes in MDS. Disclosures: No relevant conflicts of interest to declare.

scholarly journals COVID-19 in Pediatric Hematopoietic Cell Transplant Recipients: A CIBMTR Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2868-2868
Author(s):  
Neel S. Bhatt ◽  
Akshay Sharma ◽  
Andrew St. Martin ◽  
Michael Martens ◽  
Marcie L. Riches ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Publicly Traded ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hct ◽  
The Past ◽  
The Us ◽  
Salary Support

Abstract Background: Adult recipients of hematopoietic cell transplantation (HCT) are at a very high risk of adverse outcomes after COVID-19 (Sharma A, Bhatt NS, et al. Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study. The Lancet Haematology. 2021 Mar 1;8(3): e185-93). While children are known to have better outcomes after COVID-19 compared to adults in general, data on risk factors and outcomes of COVID-19 among pediatric recipients of HCT are lacking. Methods: Using the data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between March 2020 and May 2021, we describe characteristics, severity, treatment approaches, and outcomes of pediatric HCT recipients who were ≤21 years of age at COVID-19 diagnosis. All diagnoses, donor choice/graft sources, and conditioning regimens were included. Patient, disease, and HCT-related factors were described as frequency for categorical variables and median, range, and interquartile range (IQR) for continuous variables. The probability of overall survival after COVID-19 was calculated using the Kaplan Meier estimator. Additionally, an analysis was performed in the subset of allogeneic HCT COVID-19 cases from the United States (US) to identify risk factors for developing COVID-19. COVID-19 cases were compared with a cohort of all pediatric allogeneic HCT recipients without COVID-19 matched by the transplant center. Impact of hematopoietic cell transplant comorbidity index (HCT-CI), HCT indication, donor type, conditioning intensity, graft vs. host disease (GVHD) prophylaxis, and occurrence of acute and chronic GVHD on development of COVID-19 was examined using Cox proportional hazards model. Hazard ratio (HR) and 95% confidence intervals (CI) were provided. Cumulative incidence of COVID-19 among the US centers reporting at least 1 COVID-19 infection was also calculated, using death from any cause as a competing risk. P value &lt;0.05 was considered statistically significant for the analyses. Results: A total of 167 pediatric HCT recipients (allogeneic, allo: 135 and autologous, auto: 32) met study inclusion criteria. Median age at COVID-19 diagnosis for allo and auto HCT recipients were 15 years (range &lt;1-21y) and 7 years (range 1-21y), respectively. Median time from HCT to COVID-19 diagnosis was 15 months (IQR 7-45) for allo recipients and 16 months (IQR 6-59) for auto HCT recipients. Forty-two percent (42%) of the patients had at least one comorbidity prior to HCT. Thirteen percent (13%) were receiving immunosuppression within six months prior to COVID-19 diagnosis. COVID-19 disease severity was mild in 87% of patients, while 4% of patients had severe disease requiring mechanical ventilation or supplemental oxygen. Only 36 HCT recipients (22%) received any COVID-19 directed therapy. Median follow-up from COVID-19 diagnosis was 53 days (range 1-270) and 37 days (range 1-179) for allo and auto HCT recipients, respectively. The overall probability of survival at 45 days was 95% (95% CI 90-99%) and 90% (95% CI 74-99%) for allo and auto HCT recipients, respectively (Figure 1). Forty-five (45) day survival was lower among recipients transplanted at the transplant centers outside the US [non-US recipients 85% (95% CI 71-95%) versus US recipients 98% (95% CI 93-99%)]. No deaths occurred in patients who had received a transplant between 2000-2013. The primary cause of death was COVID-19 in 54% of patients and primary disease in 38% of patients. In the subset analysis restricted to pediatric allogeneic HCT recipients transplanted at the US centers (n=34), the cumulative incidence of COVID-19 infection was noted to be 1.9% (95% CI 1.2-2.9%) at 6 months post-HCT and increased to 4.7% (95% CI 3.4-6.3%) by 1-year post-HCT. Cox regression analysis showed that compared to HCT-CI score of 0, patients with HCT-CI score of 1-2 were more likely to develop COVID-19 (HR 1.95; 95% CI 1.03-3.69, p=0.042). Underlying diagnosis, donor type, treatment exposures, or GVHD did not predict COVID-19 incidence. Conclusions: This is the largest series to date summarizing the cumulative incidence, risk factors, and outcomes of pediatric HCT recipients with COVID-19. Patients with pre-HCT comorbidities were more likely to develop COVID-19. However, the overall disease severity and mortality after COVID-19 were low in this patient cohort. Figure 1 Figure 1. Disclosures Bhatt: Rite Aid Corporation: Divested equity in a private or publicly-traded company in the past 24 months; Pfizer Inc.: Divested equity in a private or publicly-traded company in the past 24 months; Moderna, Inc.: Divested equity in a private or publicly-traded company in the past 24 months; Johnson & Johnson: Divested equity in a private or publicly-traded company in the past 24 months. Sharma: Medexus Inc: Consultancy; Spotlight Therapeutics: Consultancy; Vindico Medical Education: Honoraria; CRISPR Therapeutics: Other, Research Funding; Novartis: Other: Salary support paid to institution; Vertex Pharmaceuticals/CRISPR Therapeutics: Other: Salary support paid to institution. Riches: ATARA Biotherapeutics: Other: Payment; Jazz Pharmaceuticals: Other: Payment; BioIntelect: Membership on an entity's Board of Directors or advisory committees. Dandoy: Omeros: Other: Consulted and received Honorarium.

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